Information provided does not guarantee coverage or payment. Providers must reference provider manuals for specific coverage information or program limitations and verify if services are covered for their provider type and specialty and the member. All fields are required.

Disclaimer: Effective with dates of service on and after February 1, 2016, out-of-state and border city hospitals do not receive the adjustment factor/rate that is applied to “Outpatient Services – For Outpatient Hospital Claims (OPS)”.

Disclaimer: Effective with the processing date of July 28, 2017, retroactive to dates of service on and after July 1, 2017, the previously implemented provider payment reduction was restored. Claims with a date of service prior to July 1, 2017, continue to receive the reduction. Effective for claims with DOS on and after 07/01/2018 the DRG adjustment percentage was increased to 78% for outliers (both cost outlier and day outlier).